Basic Information
| Provider Information | |||||||||
| NPI: | 1760471056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOPKINS | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 PROFESSIONAL PARK DR | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234340642 | ||||||||
| FaxNumber: | 4234349963 | ||||||||
| Practice Location | |||||||||
| Address1: | 2428 KNOB CREEK RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376042396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232825054 | ||||||||
| FaxNumber: | 4232830516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 02/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 35042 | TN | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3862559 | 05 | TN | MEDICAID |